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- St, ~UCIE CflllN~1. ~ll~,
Declarotion of Domicile and Citizenship
TO THE STATE AND COUNTY TAB ASSES.gOR,
S'i'e LIICI= COUNTY. FLORIDA:
This is my declazation of Domicile sad Citizenship in the State of Florida that I am flliny this day in
accordance, sad in conformity with Chapter 222, Section 222.17, Florida 3tatutea.
I was formerly a 1e2s1 resident of~Lli_______-----------------------____-. ---__-_--
(Cib) (at:t.)
and I ri~iuud at.Co~'_=~ Te~± ~==~_-= -__- - --__--. However, I have chitn~ed my domicile
- - - -----------------
(&erat sad NnDabar)
to and am and have been a bona dde resident of the State of Florida since----~.~4ih--__--- -- - ----------..day of
-------------J~atiar~~_____-_-~ 18 ~l , and i reside at-____Ronts_S -Bcac 4478__---
----------------------------
(8traat sad Nnmbar)
FQr~_~iero • ______ -_-. - St _ Luoie __--
_---------~-`_--------County. Florida,
(Ctb)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in
- the State of Florida.
(Inaart bare anp partineat tads, such as as4 of pert~r or basiaraa, or raliaQuisbmaat at amplo~mant at
former domielle, ramo~sl of tamib to saw domkila. pwcbaaa os bore. ale.)
8ntsring three ehildren i~ publio- school.
1- l4r~ori• I.ee Lenned~
E• Charlotte I.uoille Sennedy
S- ~ilsy Thomas ICenne(>ry
~iss
FILED AND RECORDED
h!~~~~~~~'~O~K
19b:r EG -7 Ah! 9:54
wue, k rCsTQRS Q~'~C. ~ /j/
,; .
.- •, ~ - -,
I FURTHER CEBTIFY that I will re~iater st n~ local address when the registration hooka reopen.
and comply with aU other requirements of a legal resident of Chia State.
I r UItT~ic ~rriF'Sc that I have no tntentioa to return to may form domicile, sad I is t°:.3 ~: r~.:,a:u
in_~ ?ort -Pierce 8t. 7•moi• -~~~ ~~,
p~. (G1b)
~ r
.. - ~~l.111• Itae a~(xati. -
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~warn to and wbacsib~ ~tiMi'd~ ~, ~ ~
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•:
s ~ -' ,
of
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(r. Da e~aeoli
so... awa+s a.. m.c
WTI wid! CMe1t proek O~r~. asi issiksa wlt>- ~ Aseersrr)